本帖最后由 dol528phin 于 2015-4-16 21:57 编辑
清明期间，白河蜜蜂峡谷发生了冲坠事故。事后，相关人员回忆了事发经过，认真写出了事故报告。岩友们不但对“保护员版本”中事故发生的原因及教训进行了讨论，同时也对“旁观者版本”中事发现场急救处理的部分进行了延展。基于本次事故，我发现了自己在攀岩运动中一个隐匿很深但又至关重要的盲区——攀岩运动的急救。我问自己：如果一起攀岩的小伙伴不幸发生了事故，我是否具备必要的急救常识？我是否知道如何简单地评估环境状况和伤者的状况？我是否具有去寻求救援的能力？结果令自己乍舌，竟无答案以对。带着这些问题，我在https://www.thebmc.co.uk上找到了一篇文章，在这里翻译出来，抛砖引玉，不为别的，至少大家可以从现在思考起来类似的问题。（转载请与我联系）
~~~敬请阅读~~~
First AID for rock climbers
A few bASIc skills can prEVENT drama turning to tragedy
Nick Arding
写给岩者的急救知识
掌握几个基本技能，即可防止悲剧的发生
翻译 芽子
Many people have done a first aid course in the past. But afterwards it’s easy to let the knowledge slip. But just what are the basics of first aid that every climber should know?
From that distant course you might remember the ‘ABC’ priorities (Airway, Breathing and Circulation) and a few procedures, but applying them under extreme stress can become a very different matter. Let’s take a look at a few of the basic skills and how to apply them.
很多人以前都学习过急救课程。但随后这些急救知识很容易就被遗忘了。那么有哪些基础的急救知识是每个攀岩者都应该掌握的呢？
你可能还记得，很久以前的那门急救课上所教过的“ABC”顺序（A开放气道，B人工呼吸，C胸外按压）和一些其它的程序，但在强大的压力之下运用这些知识还是很有困难的。下面就让我们来看看这些基础急救技能是怎么应用的吧。
You can’t save everyone
There are two extremes of casualty; those who will live despite you inflicting your worst first aid upon them, and those who will still die despite the efforts of a full A&E resuscitation team. But in the middle are the third group - those who will be saved by their mate opening their airway or sUCCessfully stopping CATastrophic bleeding.
你无法拯救所有人
有两种极端的伤者：一种是那些即便你使用了最糟糕的急救方法在他身上，他也能活下来的情况；还有一种是即便一个完整的急救队伍都对他进行施救也不能挽救他的生命。但在这两种极端的伤者之间还存在着第三种伤者——因为同伴们保持了畅通的气道和进行了成功的止血处理而获得了重生。
Simple as ‘ABC’
Most first aid courses follow this mnemonic so you can remember what to do under stress – like when you’ve watched your partner crater. ‘A’ stands for Airway, but it can also stand for Assess. Assessing the situation for danger is your first priority –there’s no point in getting killed before you can offer help.Then turn to the casualty. If they’re screaming their head off you can breathe a sigh of relief, they’re conscious and breathing - all you need to worry about is them bleeding to death.
简单就如“ABC”
大多数的急救课程都使用这样的记忆方法，以便你能够在压力环境下还可以记得住——比如眼看着你的朋友遭受不幸。“A”代表“气道”，但同时它也可以代表“评估”（Assess）。评估环境的危险是你首先要考虑的事情——你自己都性命堪忧，那其他的就都没有意义了。
然后再转回来说伤者。如果伤者还可以喊叫，那你就可以松口气了，他们至少还有意识和呼吸——你所要担心的就是他们会不会因为失血过多而死亡。
Coming up for air
The silent casualty is a situation to dread, as you need to start diagnosing some pretty vital stuff without any help. First open their airway. This is really easy and involves carefully tilting the head back, opening the mouth and pulling the chin forward. Look inside the mouth to make sure there are no broken bits in the way and then listen for breathing. An unconscious casualty may not have the muscle tone to keep their tongue from blocking their airway and this simple manoeuvre has saved lives countless times. “But what if they have a broken neck?” is a common question. Well, one sure way to die from a broken neck is if you can’t breathe at the same time. If you can’t detect any breathing then it’s possible that either you’ve missed it or they’ve had a heart attack. The only thing that can revive a heart attack victim is a defibrillator and some pretty advanced drugs. CPR may help keep the person alive for a limited amount of time but must be started as soon as possible.
透气
伤者不发出声音是一种比较可怕的情况，而你需要在没有任何帮助的情况下开始诊查一些很重要的体征。首先就是要开放伤者的气道。开放气道很简单，它包括小心地让伤者的后脑以一定角度倾斜，让他的嘴张开，然后将他的下颌上提（压额提颌）。清理口腔中的异物，然后听伤者的呼吸。在伤者失去意识的情况下，为防止伤者的舌头梗阻气道，要使他舌根离开咽后壁，这简单的一招已经拯救过无数的生命了。经常有人问，“如果颈椎受伤了呢？”。好吧，如果伤者不能呼吸，即便你不移动他，他也是活不了的。（译者：此时建立通畅呼吸应该优先于预防潜在颈椎伤）如果你检测不到任何呼吸，那就可能是你错过了，或者伤者心脏病发。如果是心脏病发，那能够使他复苏的唯一方法就是使用除颤器或注射药物。心肺复苏（CPR）也可以帮到一些人，但是数量非常有限，而且要在第一时间对其施救。
Stopping the flow
Conscious or not, the next priority is bleeding. Massive external bleeding is not only easy to see but can be relatively easy to stop. Apply direct pressure with a pad (a NATO First Field Dressing is the best thing) but check the wound first to make sure you don’t drive anything deeper into the wound. Arterial bleeding is difficult to stop - you have to press really hard in exactly the right spot. Internal bleeding from the chest, belly, pelvis or thigh is just as serious but more difficult to diagnose and impossible to stop without surgery. If the casualty is going into shock (rapid weak pulse, rapid breathing, cold and clammy) then suspect internal bleeding. Treat for shock (raise the legs and keep warm) and seek evacuation as soon as possible.
止血
不论伤者是否还有意识，下一件要优先处置的就是止血。大量的外伤流血容易看到，也容易进行止血处理。直接使用衬垫施压（最好是止血包），但在此之前一定要检查伤口，保证这样做不会使其它物质深入伤口。动脉出血的止血方法比较有难度，你需要很使劲地按压正确的部位。胸腔、腹腔、盆腔或下肢的内出血也同样严重，不但不易诊断，而且还只能通过外科手术进行止血。如果伤者发生休克（表现为脉搏微弱、呼吸急促和身体湿冷）那么他可能就是发生内出血了。那就要按照休克的情况进行急救处理（抬高双腿、保持体温）然后尽快寻找撤离方法。
Head injuries
A common climbing injury that often looks worse than it is. A wound to the scalp bleeds profusely but may not be too serious. As with other bleeding, check the wound site and apply direct pressure. A fractured skull is far more serious and may also involve a compression injury to the brain. Either way there’s not much you can do apart from to monitor their vital signs (pulse rate, breathing rate and size of pupils) as a record of this will really help when they get to hospital. Protect the casualty from the environment and get a rescue team in as soon as possible.
头外伤
头外伤是攀岩运动中常见的伤害，而且实际伤害经常比看上去要严重。头皮损伤造成的大量流血可能没那么严重。和其它止血处理一样，可以检查伤口然后采取指压止血的方法，可是如果头骨破裂的话，伤情就很严重了，也许会伴有大脑的压迫性损伤。但不论是哪种情况，你除了能够监测他们的生命体征（如脉搏率、呼吸率和瞳孔尺寸），其它的你也无能为力了。但这些生命体征的记录在伤者送达到医院后可以起到很大的帮助。这时应该保护伤者免于环境的伤害并尽快引导救援人员到达现场。
Leaving the casualty
With the possibility of fractures to the spine and pelvis in any climbing fall, the casualty should only be moved if absolutely necessary. But if you’re leaving an unconscious casualty to fetch help you must leave them in a safe airway position. Some call this the recovery position but it doesn’t really matter what the position is, so long as any vomit or mucus produced by the casualty drains out of their mouth rather than going back down their throat. Get them in this position as carefully as you can without twisting or bending their spine (a cushion or rolled up fleece under the head helps) and make sure they won’t roll when you leave them.
暂离伤者
在任何坠落事故中，攀岩者都可能会发生颈椎或盆骨的碎裂，所以不到万不得已一定不要移动伤者。如果你要离开失去意识的伤者前去寻求救援，那就要让伤者保持一个气道畅通的姿势。有人称这姿势为复苏体位，但其实它没有什么固定的姿势，只要伤者嘴里的呕吐物或黏液不倒流回喉咙就好。小心地将伤者安置在这个姿势，不要让伤者的脊椎有任何的扭曲或弯曲（可以用靠垫或圈起来的抓绒衣垫在伤者颈部的下方）并确保在你暂离并寻找救援的这段时间他不会翻身就可以了。
Finally
Do a first aid course if you’ve not done one in the past, they can even be quite fun! And if it happens for real, remember that you can only do your best. And the best thing you may be able to do is to keep that airway open.
最后
如果你以前没有上过去急救课程，那就去报读一个吧，课程还是相当有趣的！如果真的有伤情发生，记得要竭尽所能。而你能做到的最重要的事情就是保持伤者气道的畅通。
EXPERT Q&A
专家问答
Q. What’s the best way to cope with the stress of a real life situation?
A. Stress is manageable if you have a system to guide you through the incident. Mountain and Cave Rescue use the ABCDE system, others use DR(s)ABC and some use ABC. All are correct and the best advice is to take five seconds when you reach an incident to take stock, think through your system and act positively and safely.
问题：进行急救时，如何应对现实情况中的压力？
回答：如果在事故发生过程中一直有一个急救系统来引导你，那压力就可以得到管理了。山地和洞穴救援组织使用ABCDE急救系统，其它组织使用DR（s）ABC急救系统，还有一些组织使用ABC急救系统。这些急救系统都是正确的，同时，还有一个好的建议，那就是在发生事故的时候先思考5秒钟，用这5秒来评估状况，回忆你所掌握的急救系统，然后再安全地积极地实施救援。
Q. What should you have in a climbing first aid kit?
A. It depends. Think about what commonly happens and what you need to deal with a more serious injury. Take enough for the number of people in your party but you don’t need to carry an ambulance. Keep it simple. I use an ABCDE system for packing a first aid kit. A – Universal protection (gloves, waste bags etc), B – Pocket Shield for CPR and something to seal an open chest wound (tape and a plastic bag), C – Nato First Field Dressing for a major bleed, plasters, blister kit & medi wipes, D – Triangular bandages x 3 for immobilising fractures and some duct tape. E – Everything else like warmth, shelter, light, sugar etc. For remote locations consider drugs, fluids, sutures and advanced second aid equipment. But if you carry it, you should know how to use it.
问题：攀岩的急救包中都应该有什么？
回答：答案是不一定。想想通常都会发生什么情况，你在应对比较严重的伤害时都需要哪些器材。根据一起活动的人数带够数量，但带一辆救护车就没有必要了吧！所带物品应尽量简洁。我一般会准备5个方面的急救物品。第一，通用保护（手套、垃圾袋等），第二，简易CPR急救包和一些用来包扎开放性胸外伤的物品（医用胶带和塑料袋等），第三，处置大量流血的止血包、药膏、水泡贴和医用酒精棉，第四，三个用于固定骨断裂的三角绷带和一些胶带，第五-其他杂物，例如救生毯、庇护所、光源、糖等。对于一些偏远的环境来说，还需要考虑药品、药液、缝合工具和二次救援器材。但是，只要你携带了这些东西，就一定要知道如何使用。
Q. Is there really any point in doing CPR in a remote situation?
A. In an urban environment CPR slows down the process of dying, giving time for definitive care to reach the casualty. In a remote environment, the question is whether to start or not. I’d say yes. At the very least it will ensure that you feel like you attempted everything possible, you may just get a result (highly unlikely), and the helicopter might be near that day. How long to go on for is a more difficult question, be aware that hypothermia and lightning strike casualties have been successfully resuscitated after literally hours of continuous CPR.
问题：在偏远的环境中，做CPR急救是否真的有意义呢？
回答：如果是在城市，CPR急救将延缓伤者的死亡，为最后的抢救争取了到达事发现场的时间。而在偏远的地方，问题就是是否要进行CPR急救了。我的答案是肯定的。至少它表示你已经竭尽所能了，你也许可以成功（这种情况不太可能发生），也许恰巧直升飞机就在附近。进行多长时间的CPR急救是一个比较难回答的问题，要知道为低温症和雷击的伤者进行几小时连续的CPR急救，使伤者得以幸存的案例都是有过的。
Q. How do you decide whether to move a casualty?
A. Each situation is different. But if you have to move them into safety or into a safe airway position prior to leaving them then do so. Just be very careful.
问题：如何决定是否移动伤者？
回答：每种情况都各有不同。如果你必须要移动伤者到安全地方或将他们的体位改变为一个气道畅通的姿势，那是可以的。但要非常小心。
Q. Can you be held liable if something goes wrong?
A. Yes and no. This is civil law, judged on existing cases and the circumstances of each situation. However, you will not be judged against what an expert would have done – if you’ve been acting with the best intention of saving a life you should be OK. You must gain the consent of a conscious casualty first as they do have a legal choice as to whether to accept your help.
问题：如果做错了，你是否对后果负有责任？
回答：是也不是。这属于民法的范畴了，判决将基于现存的案例和每次事发的环境。但是，法律不会用对专家的标准来评判你，如果你当时是出于善意地去挽救生命应该是没有问题。如果伤者是有意识的，那你就应该首先获得伤者的同意，他们是有法律权利选择是否接收你的帮助的。
关于作者
Nick Arding is an AMI member and a trainer and assessor with Adventure First Aid. Having spent much of the past 30 years in the mountains he has plenty of first hand experience at applying sticking plaster to other broken climbers.
Nick Arding 是AMI组织的会员，同时也是探险急救方面的训练员和顾问。因为在过去的三十年里，他在山中度过了大半时间，使得他在为受伤的登山者包扎方面具有相当丰富的一手经验。
（免责声明：文章内容或有争议，使用前请自行判断，译者不承担任何法律结果）
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扎克斯的呐喊
这是好文章
2015-12-9 10:06
李云龙密云
涨知识，好文
2015-11-27 17:04
无敌小猪猪
支持一下楼主的好活动！！！
2015-10-14 18:14
dongfanggongmu
支持好文，非常详细！
2015-6-30 19:57
dixia
支持好文章，系统学习，不但是对自己生命的负责，同时也是对攀岩及户外运动的同伴的一种责任。
2015-5-25 11:12
gesharp
这个真的好
2015-5-21 10:38
1355143795
太感谢分享，学习了。O(∩_∩)O哈哈~
2015-5-18 16:29
老狼穿越户外
说的太好了 分享
2015-5-16 10:21
手套123
野骆驼了。捡到一个像龙的石头，挖到锁阳
2015-5-14 20:56
壹嚸汙
专业，学习了
2015-5-14 20:29
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